Find Your Routine: Consistency is Key
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our new series, Find Your Routine, we interviewed our most productive coders and asked them what steps they take to find a rhythm that works for them.
This week, we talked with Crystal Junkins, CCS, CPC, Coding Specialist with Health Information Associates, about the steps she takes to find her routine.
Q: Describe in detail your daily routine.
A: I’m an early bird – and so is my baby. I am up at 5:30 to feed the baby and have my first cup of coffee. I make breakfast for the two of us, and then switch off baby duty with my husband and the dog and I head upstairs to my office by 7:00. I read emails and go through my pending charts list, and then code until coffee break around 10. I code again until lunch and then break to feed the baby, and let the dog out. I finish coding around 3 in the afternoon, and then head right out the door to pick up the older kids from school – and then it’s homework, various sports and music lessons, prepping and eating dinner, reading, and then bedtime.
Q: How do you maintain your routine day after day, week after week?
A: I think I am just naturally a creature of habit. Health is a real priority, eating right, taking care of myself, getting enough sleep… all of that helps me maintain a regular rhythm at work as well as in my personal life as a mom to 3 busy boys. Our family life is so full of various schedules and responsibilities that the daily/weekly routine is pretty much created for me.
As far as coding goes, one obstacle I have noted to maintaining a rhythm mainly occurs when I am switching to a new client. I have often found it very challenging to start at a new client, especially since it definitely slows down my productivity quite a bit at first. However, I know that it has been a great asset for me professionally to learn how to adapt quickly to new clients, new relationships, new software, and new ways of approaching coding. HIA is constantly pushing me to grow, and that’s definitely one of the things I love about working here! So when I am starting a new client, I try to take some time to figure out the best workflow for that particular site, as it can vary so much from one place to another. They all abstract a bit differently or store their documents and information in new places. And then once I get into a fluent workflow, I stick with it. I generally go through every chart exactly the same way (abstract/discharge disposition, admit order, CDI notes, H&P, Discharge Summary, Op notes, Consults, Progress notes, anesthesia notes, labwork/etc). I think being consistent in this way helps me hit my productivity numbers at a new client faster.
Q: What techniques have you found to minimize distractions?
A: One thing that is very helpful is just the location of my office in our home. I am upstairs tucked away in a spare bedroom, far from the kitchen and living room downstairs which is often a bustle of activity between the comings and goings of my husband, the dog, the 2 older boys, the baby and the nanny who watches him during the day while I work. I really can’t hear much of anything up there! I also leave my cell phone on the charger in the kitchen during the day and just check it when I come downstairs for lunch or coffee. I focus a lot better when it’s quiet, so I usually don’t have music playing either.
Q: What are the productivity goals that you set for yourself? And how do you track them?
A: Well – it’s great that HIA does the productivity tracking for me! I just try to log in and do my best every day. Some days seem to flow really smoothly and feel easily productive. And then some days… just feel really slow and challenging. I try not to worry about the numbers and just figure that the good and the bad days will balance each other out in the end.
Q: What motivates you the most? Positive feedback from managers, self-motivation by reaching personal goals, financing incentives? Or other?
A: Yes, all of those things are motivating. But mostly, I just like to end every day feeling like I did a good job. My dad told me that was the most important thing – and he’s right.
TIP: I know for sure that I am not the fastest chart reader around, but I am definitely a fast typer. I am a piano performance graduate – so I know I have a head for memorizing information and fast fingers.
I am sure typing fast helps a lot, but more importantly, I think I am always looking for ways to type less. I know that CAC programs can be controversial, but I definitely make use of it as a tool when I am working for a client who is utilizing auto suggested codes. I use the CAC codes as much as possible, when I am confident that the suggested codes are correct. At first I was hesitant to use the codes the CAC was suggesting, but now that I am becoming more familiar with the I10 codes, I can save a lot of time by entering the codes and POA status through the CAC instead of typing it all in. The fewer key strokes the better! I know my productivity has gone up since I started making better use of the CAC.
In Part 2 of our Sepsis Series, we are going to focus on sequencing of sepsis when the diagnosis is clearly documented. Later in the series we will look at what to do when the diagnosis is not clearly documented.
In this series, we will learn what sepsis is or causes of sepsis, how to sequence the diagnosis in ICD-10-CM, what are the clinical indicators for sepsis, is a query necessary before reporting the diagnosis of sepsis, and how to prevent denials on sepsis records.
In the previous three parts of this four part series, we discussed the new ICD-10-CM diagnosis code changes, ICD-10-PCS procedure code changes and FY2020 IPPS changes. In this last Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments for FY2020.
In the previous two parts of this four part series, we discussed the new ICD-10-CM diagnosis code changes and ICD-10-PC procedure code changes. In this session we will review the major IPPS changes for FY2020. On August 2, 2019, CMS published the Final Rule for IPPS (CMS-1716) FY2020 IPPS Final Rule.
In Part 1 of this 4 part series we discussed some of the new ICD-10-CM diagnosis changes. In Part 2 we present the significant ICD-10-PCS procedure code changes. There are 72,184 total ICD-10-CM codes for FY2020.
This is Part 1 of a 4 part series on the FY2020 changes to ICD-10 and the IPPS. In this part, we discuss some of the new ICD-10-CM diagnosis changes. There are 72,184 total ICD-10-CM codes for FY2020.
We have finished with the step-by-step coding tidbits on coding of spinal fusions. If you were not able to catch Parts 1-13 of this series focused on spinal fusions, please visit hiacode.com/topics/series/spinal-fusion-coding/.
In Part 12, we focused on intra-operative peripheral neuro monitoring used during spinal fusion surgery. In Part 13, we are going to focus on harvesting of autograft and is it coded. Remember in Part 6, we learned that autograft is bone from the patient.
In Part 11, we focused on identifying the computer assisted navigation used during spinal fusion surgery. In Part 12, we are going to focus on intra-operative peripheral neuro monitoring.
In Part 10, we focused on identifying whether or not hardware from a previous spinal fusion is coded. In Part 11, we are going to discuss computer assisted navigation.
In Part 9, we focused on identifying if decompression was also performed and if so, on which body part. In Part 10, we are going to focus on identifying if hardware was removed from a previous fusion site.
In Part 8, we focused on identifying if a discectomy was performed, and if so, if it was a partial or a total discectomy. In Part 9, we are going to focus on identifying if a decompression was performed, and if so, was it of the spinal cord, spinal nerves or both?
In Part 7, we focused on identifying any instrumentation that may be used during a spinal fusion. In Part 8, we are going to focus on identifying if a discectomy is performed and if this is an excision or a resection of the disc.
In Part 6, we focused on identifying the type of bone graft product used for the spinal fusion. In Part 7, we are going to focus on identifying any instrumentation or device used.
In Part 5, we focused on identifying the approach being used for the spinal fusion. In Part 6, we are going to focus on identifying the type of bone graft used for the spinal fusion.
In Part 4, we focused on determining the spinal column being fused. In Part 5, we are going to focus on identifying what approach is being used to complete the spinal fusion (anterior, posterior or both).
This past year, HIA implemented “Buddy Up,” a program designed to help the new hire have a smooth transition into their new HIA roles with the assistance of a “buddy.” What is a Buddy? The Buddy is simply a peer who can guide the new hire in order to make them feel more comfortable. We are very proud of this program and have many success stories that we would like to share. Take a look at the wonderful feedback we have received below.
In Part 3, we focused on determining the level of the fusion(s) and how to determine the number of vertebrae fused. In Part 4, we are going to focus on identifying which column is being fused (anterior, posterior or both).
Part 3: Spinal Fusion Coding — Determine the Level(s) or Region of Fusion and Number of Vertebrae Fused
In Part 1, we learned the diagnoses associated with the need for spinal fusions, and in Part 2 the need to identify if the fusion is an initial or refusion of the vertebrae. In Part 3, we are going to focus on determining the level(s) of fusion, as well as the number of vertebrae fused.
In Part 2, we are going to look at the differences between initial fusion and a refusion. In ICD-9, there were specific codes to show if the fusion was an initial fusion, or if it was a refusion. In ICD-10-PCS, initial fusions and refusion procedures are coded to the same root operation “fusion.”
This is Part 1 of a 14 part series focusing on education for spinal fusions. Spinal fusion coding is a tough job for coders. There are so many diseases/disorders that result in the need for spinal fusion, and even more choices in reporting the ICD-10-PCS codes.
The official definition from the Centers for Medicare & Medicaid Services (CMS) states that a Medicare overpayment is a payment that exceeds amounts properly payable under Medicare statutes and regulations. When Medicare identifies an overpayment, the amount becomes a debt you owe the Federal government.
The question asked in a physician query may be the most important element of the document. Query questions need to be as simple and concise as possible. The physician should have no doubt what the coder is asking.
We interviewed our most productive coders, reviewers and members of our education team, asking them what steps they take to find a rhythm that works for them. This week, we talked with Beth Martilik, MA, RHIA, CDIP, CCS, Assistant Director of Education, about the steps she takes to find her routine.
With the implementation of ICD-10-CM came more codes for reporting many different conditions and diseases, and atrial fibrillation is one of those. For many years there was only one code available for reporting this condition, even when the physician further specified the type of atrial fibrillation that the patient had. In ICD-10-CM, there are four codes to report atrial fibrillation.
We have a case where the physician removes mucoid casts found during bronchoscopy. We have also seen mucus plugs removed during bronchoscopy. The MD performs bronchial washings then removes a large amount of tenacious and thick mucoid casts via bronchoscopy. Is this coded drainage, extirpation or excision? What body part is used?
The key to making the query process more efficient is to look for words or documentation while reviewing the record that may signal a potential query opportunity and to note the finding at that time. By the time a coder reaches the end of a record, documentation may have been found to eliminate the need for the query.
Question: This patient is noted to have “Lymphangitic carcinomatosis of lungs with mediastinal lymph nodes.” How would I code the diagnosis? Would I code metastatic cancer to the lung (C78.01) or metastatic cancer to the lymph nodes (C77.1)?
Coding these can be challenging for coders when trying to decipher the operative notes and terms that are used. The physicians are still using the terms excision and resection interchangeably and review of the entire operative note is required to select the appropriate root operation. Remember, it is the coder’s responsibility to determine the root operation based on the details from the physician in the operative report.